'Clubhouses' may be the missing links in treating mental illness, new study shows

NYU Medicaid database opens door to research

Public-health researchers have often faced excessive red tape when seeking access to state Medicaid claims. Now a new database, hosted by the Health Evaluation and Analytics Lab at the NYU Wagner School of Public Service and the Department of Population Health at NYU School of Medicine, has been designed to change that.

The goal is to optimize the data for research, rather than for billing, said James Knickman, director of HEAL, which was founded last year. The database was created with a grant from the New York State Health Foundation and support from the state Health Department.

"Now a research team can come in and start way down the line and have a clean data set organized to do analysis," he said.

Knickman and another NYU researcher recently completed the first study using the database, on New York–based Fountain House, which provides a social atmosphere, along with work and educational opportunities, for people with mental illnesses. The study looked at the impact of the nonprofit's clubhouse model on members' Medicaid costs (see Pulse box).

The state allowed NYU to design the database under the condition that researchers from other institutions would have access to it, said Knickman. Health interventions currently being studied using the database include school-based health centers, supportive housing and care-management programs. —C.L.

Mental health advocates fear Medicaid cuts

Cuts to the state's Medicaid program could reverse hard-won progress for mental health coverage if the current version of the American Health Care Act were to become law, said Christy Parque, executive director of the Coalition for Behavioral Health Agencies. Medicaid, the largest source of financing for mental health services nationwide, pays for about one-quarter of such services.

In particular, Parque said she's worried that the end of enhanced federal funding for New York's Medicaid expansion in 2020 could lead to a rise in the ranks of the uninsured, causing a surge in costly emergency room visits for people with mental health conditions. "We should be trying to treat people before they end up in the hospital," she said.

Parque said the state has made progress in integrating the treatment of behavioral health and primary care. House Republicans narrowly passed their bill to repeal and replace key aspects of the Affordable Care Act, but the measure still has to make its way through the Senate, where its future is far less certain.

Dr. David Lim, chief medical officer at Quartet Health, said he's hopeful that insurers will see the value of covering behavioral health. Quartet helps primary care doctors identify patients with a mental health condition and connect them to treatment. Addressing such an underlying condition can improve adherence to treatment plans for other chronic illnesses, Lim said.

"Behavioral health will be an incredibly important lever to drive health care value," he said. Lim doesn't expect the state to seek a waiver under the AHCA that would allow insurers to offer plans that don't cover mental health. "In New York there will hopefully not be a huge impact," he said. —J.L.

Jacobi taps interim CEO as permanent chief

NYC Health + Hospitals/Jacobi named Christopher Mastromano chief executive Monday, filling a key role after significant turnover among top leadership at the Bronx hospital in recent months.

Mastromano has served as interim CEO since February, when former CEO William Foley was promoted to senior vice president of acute care, overseeing all 11 hospitals in the municipal health system.

Mastromano will now head the facility permanently, as the system aims to attract more patients and close a projected $1.8 billion budget gap in fiscal 2020.

"We're at a challenging point in the health care industry," Mastromano said in a statement. "We need to transform our services to provide greater convenience to our patients and improve health outcomes."

Mastromano previously was chief operating officer at Jacobi. He spent two years at Governeur Health, leading a $275 million renovation project for the lower Manhattan site, which provides primary care, rehab and nursing home care.

Earlier in his career, Mastromano was director of provider relations at Fidelis Care and executive director at the now-closed Mary Immaculate Hospital in Jamaica, Queens. —J.L.

AT A GLANCE

WHO'S NEWS: Dr. Robert J. Cerfolio, an expert in robotic surgery, will join NYU Langone as chief of clinical thoracic surgery June 1. He also will become the first director of the Lung Cancer Center at NYU Langone's Perlmutter Cancer Center. Cerfolio currently serves at the University of Alabama Hospital in Birmingham as the James H. Estes Family Lung Cancer Research Endowed Chair and chief of thoracic surgery.

Robin Honig will join Columbia University's College of Physicians and Surgeons in the newly created role of chief financial officer, senior business officer and associate vice dean, effective June 19. She was previously associate dean of finance and administration in the biological sciences division of the University of Chicago, which includes its medical school and faculty practice.

FREESTANDING ERs: The proliferation of freestanding emergency rooms provides consumers with convenience and shorter waits but not lower costs, reported The Washington Post. There are more than 400 such freestanding ERs in 32 states, but more consumers are complaining about excessive costs for minor procedures, such as treating a cut that didn't require stitches for $6,856 or being prescribed a $4,025 antibiotic to treat a sinus infection.

'Clubhouses' may be the missing links in treating mental illness, new study shows

William, who suffers from schizoaffective disorder, first started attending Fountain House, a social center and resource hub for people with mental illnesses that's located in a stately brick building on West 47th Street, after being hospitalized last year. William said he experienced a psychotic episode after his support system crumbled, with the shutdown of his psychiatric support group and the departure of his church's longtime pastor.

"During the day I had nothing to do," said William, 42, who asked Crain's not to publish his last name to preserve his privacy. "With the isolation and the withdrawal, my symptoms exacerbated."

William, who hasn't been readmitted to the psychiatric ward in the 10 months since he joined Fountain House, credits the clubhouse model the agency pioneered. The nonprofit engages its members in the daily tasks that are vital to running the facility while also offering wellness skills, educational and employment opportunities, and care management.

A study released this week by researchers at NYU's Health Evaluation and Analytics Lab lends credence to the idea that the clubhouse model, which Fountain House has helped spread to more than 300 sites worldwide, helps cut back on hospitalizations for high-need patients, saving Medicaid money. About 90% of Fountain House members are enrolled in Medicaid, and researchers used a Medicaid claims database to conduct the study.

A group of Fountain House members who racked up more than $18,000 each in Medicaid expenses the year before they joined the clubhouse incurred monthly medical expenses that were 21% lower than anticipated during their first year as members, saving Medicaid about $783 per month. The authors found that although these 134 high-need members were costing Medicaid more money in prescription drugs and outpatient care during their first year, they were saving the system money overall because of reductions in inpatient care.

"You need that extra component, which is the community," said Dr. Ralph Aquila, medical director of Fountain House. "We understand the need for primary care, psychiatric care, but then the community you see here is just as important as any other delivery of medical services."

James Knickman, who co-authored the study, said he was surprised by the results. "It's very hard to budge the health care expenditure needle, and I've seen so many other efforts," he said. "This is one of those cases where there's pretty strong evidence emerging that a social-service approach is reducing the actual need for medical care."

Aquila said he believes Fountain House's value to the Medicaid system is not just in helping people avoid psychiatric hospitalizations, but also in helping members access primary care services to control chronic conditions such as diabetes and hypertension.

Currently, Fountain House relies on the government for about 69% of its revenue. Aquila said the center aims to increase its clinical partnerships and the funding it receives from Medicaid in the future.

But for William, who copy edits the Fountain House newsletter and produces audio stories about members to share with donors, what keeps him coming back are the relationships he has formed and the opportunity to hone his professional skills.

"Fountain House gives me structure, it gives me community and it allows me to have a place to come to every day where I'm needed," he said. —C.L.

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